Module 2: Cervix in Pregnancy

Question 1

what are the three methods to asses the cervix

Answer 1

• transabominal
• transvaginal
• translabial

Question 2

what is needed for the transabdominal approach to be effective

Answer 2

• partially full bladder

Question 3

what can happen to the patients cervix if the bladder is too full

Answer 3

• falsely elongate the cervix by compressing the lower uterine segment and making it look like its part of the cervix

Question 4

what other situation can make a sonogpaher falsely elongate the cervix other than a full bladder

Answer 4

• uterine contractions close to the cervix

Question 5

when is the translabial approach used

Answer 5

• used when ruptured membranes has occurred

- or with placenta previa

Question 6

what is the translabial approach limited by

Answer 6

• rectal gas

Question 7

does the patient need a full bladder with the translabial approach

Answer 7

• no

Question 8

what method is the gold standard (most accurate) for measuring cervical length

Answer 8

• transvaginal

Question 9

how far should the EV probe be inserted to measure cervical length

Answer 9

• 3-4cm

Question 10

when is EV contraindicated to measure cervical length

Answer 10

• when ruptured membranes has occurred

Question 11

what two things can the EV exam cause for the patient

Answer 11

• bleeding

- contractions

Question 12

what does the normal cervix look like on ultrasound

Answer 12

• echogenic canal (mucous plug)

- can appear hypoechoic

Question 13

what is the lower limit of normal for the cervix

Answer 13

30mm

Question 14

what does a cervix of 15mm correspond too

Answer 14

50% effacement

Question 15

what does a cervix of 10mm corresponds too

Answer 15

75% effacement

Question 16

what is funnelling

Answer 16

• herniation of the fetal membranes into the internal os but the external os remains closed

Question 17

what is funnelling an early sign of

Answer 17

incompetent cervix

- increased risk of preterm delivery

Question 18

what AP measurement is considered abnormal cervical dilation before 30 weeks

Answer 18

> 5mm

Question 19

what is cervical incompetence

Answer 19

• dynamic process

- cervix changes spontaneously and dramatically in a short period of time

Question 20

when does cervical incompetence occur

Answer 20

• cervix is unable to retain a pregnancy to full term

Question 21

how is cervical incompetence acquired

Answer 21

• laceration of the cervix due to excessive dilation with a D&C

Question 22

how is cervical incompetence congenitally acquired

Answer 22

• having a misshapen uterus do to DES exposure

Question 23

what is the classic presentation of cervical incompetent

Answer 23

• painless cervical dilation

- history of recurrent second trimester losses

Question 24

what is the DDX of cervical incompetence but what is the difference between the two diagnosis

Answer 24

• pre term labour
• patient will be experiencing contractions
• contractions strong enough to change the cervix
• cervix will then dilate

Question 25

what is the treatment for an incompetent cervix

Answer 25

• cervical cerclage

Question 26

what is a cervical cerclage

Answer 26

• purse string suture is applied to the cervix

- inserted between 13-16 weeks in patient with a known cervical incompetence

Question 27

what conditions do patients have an increased chance of getting sue to a cerclage

Answer 27

• amnionitis

- rupture of membranes

Question 28

what does a cerclage look like on ultrasound

Answer 28

• hyperechoic linear structure with acoustic shadow seen in anterior and posterior cervix

Question 29

what are three other names for cervical cerclage

Answer 29

• shirodkar suture
• McDonald suture
• transabdominal